MALLET FINGER

GENERAL



A sudden bending force to the tip of the finger causes a Mallet finger - e.g. tucking in the sheets while making a bed.

It can either...

Stretch or Rupture the tendon,



or, pull a fragment of bone off the end bone of the finger.



It results in a drooping deformity at the end joint of the finger, which, if left untreated, can increase progressively with time.

TREATMENT

The fingertip should be held straight for 8-10weeks to allow the tendon to heal. This is followed by a period of night splinting and the use of Coban bandage during the day for 2 weeks.

Note - the finger must be kept dry.

The splint should be comfortable. If the finger is painful then the splint can be carefully removed and the back of the finger massaged with an alcohol swab to prevent ulcer formation. During this time the finger must be supported straight at all times. If the finger drops for even one second the treatment can fail. The splint is best reapplied with the assistance of another person.

If the splint feels too tight it usually is and should be carefully adjusted.

As the swelling and pain settles the splint can be bent back more to decrease the strain on the tendon. If the tape stretches new tape can be applied over the top of the old tape. The finger should feel firm in the splint.

The second finger joint (P.I.P. joint) should be exercised to prevent stiffness.

  

Surgery is rarely required for this condition unless the end joint is dislocated. Surgery often results in permanent loss of bending (flexion) of the end joint and the results of treatment in the splint are very good if the program is carefully followed.

After the splintage period the finger should be gently exercised. It is best to regain full bend of the finger over a period of 6-8 weeks rather than force the movement and end up rupturing the tendon again.

Coban bandage can be obtained from the physio. 5 layers should be applied to the finger loosely to partially restrict the movement of the end joint for 2 weeks after the splint is removed.

  

SUMMARY



If finger drops or is still bent after 8 weeks then reapply splint 3 weeks and return for review.

THE BOTTOM LINE!

If the finger drops for even one second during the splintage period the treatment can fail.